courage

Last week I wrote a letter to Helen. It went down quite well. I’m not sure that writing to you will be quite so popular, but I feel rather strongly that you need support. Although probably not for the reasons you think.

You seem to believe that you have been badly wronged by recent events. Life is rather grim, despite the prospect of the new job. But until you take responsibility for the pain and psychological damage you caused Jess and Helen, you will continue to hurt others and yourself.

You talk about Henry and Gideon/Jack as though they were your personal possessions. Everything you say about them is expressed in relation to how you feel. This is not how good, loving parents behave. Good parents put their children’s needs before their own. They are prepared to give up anything for their children’s sake, even if that means never seeing them again. They would give up their own lives for them if they had to. Could you do that?

Your psychological development has been badly affected by your own parents. Your father is a cruel ill-tempered man who judges others harshly and withholds love. He has abused your mother psychologically for many years. She has learned to accept his put-downs and capitulate to him, including sending you away to boarding school when you were very young. This has left you deeply scarred.

You have absorbed your father’s misogynistic attitude to women. You love your mother but treat her as a useful fool. You treat the women you have relationships with as sex objects and workhorses to be manipulated and controlled. You are ultra-competitive, deeply jealous and you struggle with controlling your temper. You have an unreasonable sense of entitlement and you perceive your own attributes and the faults in others far in excess of reality. This causes you problems in your work and personal life.

Some people would describe you as a narcissist, a person whose psychological development has been arrested in response to excessive criticism or other trauma as a child. I’m not sure if such a label is useful, unless it encourages you to seek help. What I do know is that you need help. Badly. Because your behaviour is going to get you into really serious trouble one of these days. And because although you pretend otherwise, you are very unhappy.

It won’t be easy. You are going to have to rethink everything you currently believe about yourself and others.

It is possible that you can be rehabilitated. It can happen in real life as well as in a soap. And if you and the writers of The Archers can do it, it would be a good thing. It would send a positive message that it isn’t down to the woman and the criminal justice system to combat coercive control. The only thing Helen got wrong was to be vulnerable. It was you who targeted, hoodwinked, bullied, abused and raped her. So it is you who needs to change.

There are services available to help men like you. Although not nearly enough of them. Such work takes great patience and skill and it isn’t quick. But it is essential because there are far too many men who physically and psychologically abuse the women they profess to love. A few end up in prison. The majority get away with it. And go on to ruin the lives not only of those they have already abused but also of the next women and children who are unfortunate enough to form relationships with them.

So I encourage you to seek some professional help. Here are some useful numbers and websites:

Respect – organisation that specialises in helping to end domestic abuse

Refuge – website with information about help if you think you may be an abuser

If you can admit to what you have done, Rob, it would be a very good first step. You talk frequently about “being a man”. Facing up to being an abuser is what a real man would do. It will take considerable bravery. And it won’t be easy.

Helen showed immense courage in eventually standing up to you. Could you find courage like that to face yourself? I really hope so.

Thank you for opening this. You probably won’t feel up to reading much. So I need to grab your attention.

I want to tell you something. I have been where you are. I have felt that my life wasn’t worth living. Sometimes I knew why; mostly I didn’t. It has happened a number of times over many years. I have contemplated suicide. I even tried to take my life. But I’m very glad to be here because otherwise I couldn’t write to you now.

Making an admission about feeling suicidal isn’t easy. It can be shocking to face, for you and others. But also you don’t want people to overreact. You just want to be able to talk. And yet the chances are, you won’t have spoken to anyone about it. You may feel ashamed, as I once did. And still do, on a bad day.

Distress of this sort is overwhelming. Especially if you keep it bottled up. It blocks out the sun. Yes, it is different for each of us, because we are all different. But what makes us similar is the awfulness of it. Lying awake for hour after endless hour, whether alone or next to someone you can’t talk to about the darkness of your thoughts. Everything seems pointless. You worry about stuff you used not to worry about. And the big things that were worrying you already are overwhelming. You feel loathsome, undeserving and useless.

So what might have helped me when I was where you are right now?

It would have helped if I had managed to talk to a loved one or a friend. Eventually I have learned how to do this, although I still find it hard. I have been surprised by the kindness and understanding shown. Suicide is still taboo for some, but less than it was. And talking can really help.

I called Samaritans a few times, from a phone box – there were no mobile phones in those days and I didn’t want to be overheard. They were amazing. They weren’t shocked and they listened really carefully. Nowadays calls to Samaritans are free so you don’t need credit. Ring 116 123 anytime, day or night, and talk to a trained volunteer.

A hospital nurse once told me that I was a cowardly, selfish waste-of-space who had taken him away from looking after people who were really ill. I believed that nurse. And that was how I saw myself for many years. I wish I had instead remembered what a kind GP said when I apologised for bothering him, which was that I was worth the effort.

I wish could have had a smart phone installed with the #StayAlive app by Grassroots Suicide Prevention for androids or iPhones. As well as useful information, advice and support, it encourages you to store reminders of how you feel on a good day, and keep special pictures and notes in one place. Now I look at mine most weeks. It makes me feel safe.

Learning to be kind to oneself can be a lifelong project. But if you aren’t kind to yourself, it is much harder to be kind to other people. For that reason, it is a generous and thoughtful thing to do. Rather than a self-centred indulgence, as I once believed.

Thank you for reading this. I hope it helped a bit. And if it didn’t, it doesn’t matter.

Last week I was introduced by Dr Kathy McLean, Medical Director at NHS Improvement to 180 people comprising senior NHS clinicians, managers, directors, chief executives, patient representatives and members of staff at NHS Improvement, including most of their executive team. And I wondered how my homespun talk about improvement, leadership, the universe and everything would go down.

As it turned out, quite well.

The cartoon above was drawn by Inky Thinking. I don’t know how they do it, but they capture everything you say that you want people to remember.

Here is a word-based precis:

If you forget that culture always trumps strategy, your efforts to improve services will be ineffective. I’ve been there and occasionally done it the right way. But more often the wrong way.

You can’t help others to improve unless you are OK yourself. I have form on not remembering this.

Leadership in public services has never been harder with our 24/7 media, including social media, and the anti-public sector rhetoric that appears in most newspapers.

Being an NHS leader is very lonely. Never more so than when you are awake at 3am. People get in touch to congratulate you when something goes well. But when things go wrong, people you thought were friends seem to melt away.

There is never enough time to think when you are running NHS services because of competing demands, often from those who are meant to be there to help you make improvements. But you must create time to think or you will make bad decisions.

Filling senior vacancies in the NHS is getting harder. And we should worry about this. Because if we aren’t careful, the only ones who apply to be in the firing line will be those who don’t care what others think about them. And that would be very bad for all of us.

We cannot separate leadership from mental health. In my opinion, people who experience mental illness from time to time can make exceptional leaders. It is only one thing about them. Plus, they develop skills through therapy that are invaluable – such as managing their own mood, listening really carefully, and not making assumptions about others.

I have experienced depression off and on since the age of 15. A nurse said something damaging to me when I was 22 and vulnerable which I absorbed deep into my psyche. For the next 36 years I stigmatised myself, despite being an active campaigner against the stigma of mental illness. It was when I finally came out about my experiences that I was able to address my self-stigma. I have made many friends since then. But if only I had done it before, I could have been a better, more authentic leader.

Mental illness messes with your head. It affects 1:4 of us. But 4:4 of us should care about it, not just on humanitarian and economic grounds, but because almost everyone can be affected. We are all on a spectrum of resilience, and if enough bad things happen to us, especially at a young age, most of us will experience post traumatic damage.

When I appeared suddenly to get ill with an acute onset of depression in 2013, it was a culmination of things. My own susceptibility, but also workload, loneliness, weariness as I approached retirement, not taking care of myself, listening too hard to my own negative voices, and putting a lot of energy into maintaining a positive front. It wasn’t caused by internet trolls. But they didn’t help.

So please don’t do what I did. Get to know yourself. Talk to yourself honestly about how you are. Talk to your loved ones. Take care. Be the best version of you, but make sure that it is you. And try always to see yourself as an improvement project – this makes it easier to accept criticism without it cutting you to your core. I’ve only learned this in the last few years, and it is a revelation!

I am lucky. I have dear family and friends. And I got great care. I was able to go back to a job that I loved, which was a major part of my recovery. I know it isn’t the same for everyone.

Since the summer of 2014 when I finally hung up my chief executive boots, I’ve been helping others in various ways to be the best version of themselves. And I’ve written a book which I hope you will read when it is published later this year.

As I finish this blog, I think of someone who embodies improvement in everything she does. The talented, compassionate and extremely resourceful Dr Kate Granger. Kate is currently in a hospice in what are probably the final stages of a rare and awful form of cancer. But as well as sharing the intimacies of her progress through terminal illness via her wonderful talks and social media, Kate has also revolutionised the NHS and other healthcare systems around the world with her #HelloMyNameIs campaign. She has written several books, and completed amazing things on her bucket list. And not content with that, Kate and her husband Chris Pointon are urging people to make donations to the Yorkshire Cancer Centre, a small charity that helps improve the quality of life of people living with cancer. You can donate here.

Kate and Chris demonstrate that being a leader isn’t a job, it is an attitude of mind. That anyone can make a difference if they focus on something that matters, turn a great idea into an innovation and build support for it through honest endeavour. We can all learn about improvement from them.

May you go well, both of you.

25 July 2016 postscript:

Chris has just posted on Twitter that his wonderful wife died yesterday peacefully in the arms of her family.

I only met Kate once. I will never forget her. She had an extraordinary stillness and presence. I hope the knowledge of the difference she has made and will continue to make for many years to come will sustain Chris and all who loved her in the difficult times ahead.

Those who seek to denigrate her memory are more than mean – spirited. They not only question her nursing contribution in the Crimea – for which she was honoured by the British Army, the Times newspaper, Her Majesty Queen Victoria and 80,000 members of the public who attended celebrations in her honour. They also question whether she actually was a nurse. They say that she wasn’t really black. And having campaigned as hard as they could to undermine the Mary Seacole Memorial Statue Appeal, they now say that it is OK for there to be a statue to commemorate her, as long as it is small and not in a prominent position.

I will not stoop to naming these people nor to referencing the nastiness they have whipped up. Articles in The Independent and The Guardian have helped set the record straight. And today my dear friend Professor Elizabeth Anionwu CBE, Vice Chair of the Mary Seacole Statue Appeal, pictured with me above, will be on Woman’s Hour talking to Jenni Murray about the importance of Mary’s memory to all who believe in equality.

And today is the day that Mary’s beautiful statue, created by renowned sculptor Martin Jennings, will be unveiled outside St Thomas’ Hospital in London. Mary will proudly face the Houses of Parliament across the river. And she will be the first statue to a named black woman in the whole UK.

This is what will be written underneath:

“I trust that England will not forget one who nursed the sick, who sought out her wounded to aid and succour them, and who performed last offices for some of her illustrious dead.”

Sir William Howard Russell, War Correspondent, the Times Newspaper, 1857

We need Mary’s legacy now more than ever. The referendum campaign has unleashed xenophobia and racism. The poster of people with dark skin queuing for refuge with that hateful slogan underneath said it all. Some hoped such ugly days were over. Many knew this was not so. Fear and hatred for “the other” lie behind words such as “I’m not a racist but….”.

The NHS is not immune to racism. Or sexism. I have nothing against able and honourable white men. But when the NHS workforce is 70% female and 20% BME, why does the top look so male and so white? This excoriating report by Yvonne Coghill and Roger Kline tells us a lot. About unfairness and disadvantage and about how NHS staff who experience these things can lose hope. It was published earlier this month. It is in danger of sinking without trace unless we do something different now.

I have no personal experience of racism, although I have seen it in action. Sometimes I have done something about it. And sometimes I have not. For this I am ashamed.

I do have experience of anti-Semitism, of being teased for having a “funny” surname, and of sexism. I know about the stigma of mental illness. And I know that, had I stayed where I started, at a London teaching hospital, I would not have become an NHS chief executive. My face would not have fitted.

It was for these reasons that I, a white woman, felt I had something to contribute to the Mary Seacole Statue Appeal.

Trevor Sterling, new charity chair, Leon Mann, ambassador and me last year at the site of the statue

And now, trustees of our new charity, the Mary Seacole Trust, chaired by the brilliant lawyer Trevor Sterling, will be calling on Mary’s legacy to inspire those at risk of disadvantage. In schools, universities, communities and workplaces including the NHS. We will encourage people to work hard and do their best. To be compassionate AND entrepreneurial. To aspire to great things. To speak up for what is right. And never to give up.

Despite not bring born in the UK, Mary Seacole never gave up playing her part in helping those from a country she loved. Throughout her life she remained proud of her dark skin and her heritage.

I urge anyone in despair or need of inspiration to visit Mary’s statue. It depicts her coat furling around her as she strides defiantly into the wind to meet her destiny.

These are very difficult times. Let us join Mary Seacole. And let us never give up.

An earlier version of this article was published in the Health Service Journal. I have updated it for my blog and to increase access beyond the NHS. I will update it again with photographs of the statue.

We do not progress through the stages in a linear fashion. Some may have to be repeated. If we are not careful, we can get stuck at any of the first four, and never fully achieve the final one, of acceptance.

Today, those of us who voted Remain are feeling some or all of the first four stages. Only a few have reached the fifth by now. Some never will.

We have a right to feel angry. The referendum was unnecessary. Some time ago, David Cameron made a promise to appease certain members of his own party. He probably never expected to have to keep it.

After the result, the only honourable thing he could do was resign. As he did so, he was trying hard to appear to have achieved acceptance. But the catch in his voice gave the game away.

And he may never achieve it. Political careers in high office almost always end in failure. But this is failure of a most awful kind. Perhaps we can be kinder if our current Prime Minister shows statesmanship over the coming weeks and begins to chart the way through unprecedented choppy waters.

The reason many voted Leave was not about immigration or perceived European bureaucracy. It was a protest vote against the greed of big business, the banking crisis which has affected poor and vulnerable people much more than those who caused it, and a political ruling class that seems dangerously out of touch.

Can we listen really carefully to those who feel this way? We need to heed their voices, as well as the cries of anguish from those who voted Remain. And listen to both groups above the triumphal clamour of the minority who believe we have “got our country back”.

It is going to be very hard. Once hatred has been unleashed, it is hard to put it back in its cage. The rise of far right politicians and alliances are real and present dangers.

The size of turnout demonstrates that when people feel their vote will count, they are more likely to use it. So maybe we have to rethink our position on our current electoral system that disenfranchises so many.

And perhaps those towards the centre or on the left politically, if indeed such definitions are even valid in this context, can stop fighting one another and think about what matters? And who our real enemies are?

In the early stages of grief, it is important not to make momentous decisions. Words or acts of anger, hatred and blame will not help us.

So let’s hold on. Let’s be kind, to ourselves and to others. We are beaten. But we are not broken.

This time last year, I wrote a blog for newbies going to the NHS Confederation Conference. I decided to do an update for #Confed2016.

These are my top ten tips for having a fruitful time. By the way, you don’t have to be going to Manchester to make use of it 😉

Don’t try to see and do everything. Be choosy. Treat the conference like a festival. By all means tweet about what you hear. But do also give the events you choose to attend your undivided attention.

If you only seek out sessions and speakers to confirm your views, you will waste time and money. Arrive with an open mind. Ask questions. And be prepared to learn new things and to unlearn old ones.

Some people need no encouragement to network. But if you aren’t confident about bounding up to someone you admire with an outstretched paw, don’t worry. Practice saying #HelloMyNameIs to people who look like you feel – perhaps a bit lost or lonely. And remember what Dale Carnegie said: You can make more friends in two months by becoming interested in other people than you can in two years trying to get other people interested in you.

Dress for style AND comfort. These are not mutually exclusive.

Never forget you are at work. Stay out late if you must. But if someone makes you an offer you feel you cannot refuse, say No. And mean it. What goes on at conference does NOT stay at conference.

Take breaks. Go for a walk. Have a rest in your room. Do shopping or emails or visit the Lowrie. Drink coffee.

At the same time, stay focused on why you are there. The NHS is in a bad way. It is not only being slowly starved of cash. Services are overwhelmed because current methods of doing things are unfit to meet the demands of so many people with multiple problems. We need leaders like you to find two or three changes that will make the most difference. And to devote their careers to making these things happen.

Remember that innovation is as much about stopping things as starting them. That there are no quick fixes. And that culture eats strategy for breakfast*.

You will meet folk having a hard time. Please don’t avoid them. Despite all the talk about compassion, our beloved NHS has become less compassionate. There is too much focus on inspection, compliance and performance. And insufficient attention paid to recovery, renewal and support. Please spend time with people working in very tough places. Listen if they seem angry or frightened. One day, this could be you.

Take a look around you. Notice the top of the NHS. How very white and very male it is, despite the NHS workforce being 70% female and 20% BME. Ask yourself why this is so. And if you think it matters, do your bit to help to change it.

I’ve been to a few conferences. And been inspired. I hope you will be too. Have a wonderful time xxx

*This was never actually said by Peter Drucker or Edgar Schein, to both of whom it has been attributed. But it was what they meant. Sort-of.

I went to a conference in Nottingham yesterday to learn about a technique called Open Dialogue. I wanted to know more because of how it has revolutionised the care of people who are in crisis in parts of Finland and the US, reducing demand on mental hospitals and transforming lives.

I care deeply about mental health services, although I don’t run them any more. These days I campaign to make them better. I volunteer in suicide prevention. I chair the Time to Change mental health professionals project. And sometimes I need help from services myself.

I wish you could have been there too. Some massive pennies dropped, not just for me but for everyone who hadn’t already appreciated the possibilities. We learned that Open Dialogue is about being with people rather than doing something to them. And we realised that here was a way to mend things that previously seemed unfixable.

Let me explain.

There are some who say that the NHS is broken. And that mental health services are badly broken.

I’m not sure that broken is a helpful way to describe things. I prefer to think of them as badly wounded. And when someone is wounded, you take care of them.

I believe that people in highly influential positions do care about mental health. They are just unsure about what to to do, other than saying they care. They know that mental health services around the country are buckling under the strain of increasing demand. Referral rates have never been higher. And continue to climb. Services find it increasingly difficult to discharge people because there is nowhere for them to go. Staff are overwhelmed, and there is a growing recruitment and morale crisis.

Added to which, successive governments say one thing about the importance of mental health but allow the opposite to happen regarding funding. Despite the fine words and promises in the response to the Mental Health Taskforce report published in February, we heard just a few weeks ago from NHS Providers that mental health trusts are not seeing the promised investment and some are reporting funding cuts in 2016 – 2017. Parity of esteem? Actions speak louder than words.

How might Open Dialogue help?

Firstly, it isn’t simply a technique for listening really carefully to people who experience trauma and distress AND their families so that together they can work out their own solutions, with support. It is also an extremely respectful way for people to relate to one another, in teams, across teams, organisations, health care systems and society. Even the NHS.

Secondly, Open Dialogue is the antidote to what is sometimes called the biomedical model, when doctor knows best and patients are compliant. This works when there is a fairly simple problem and solution. For example, a broken leg. It doesn’t work for the vast majority of health conditions in which people need to become the expert themselves if they are to lead fulfilling lives. And it certainly doesn’t work in mental health. Mental health professionals know this. But we organise and regulate mental health services as though we were fixing broken minds instead of legs.

Open Dialogue builds on what some call the Recovery Model, based on hope and fulfilment rather than simply diagnosis and treatment. It provides a method to apply a recovery-based approach, involving the whole family and team. It is the antidote to outpatient clinics and ward rounds.

Thirdly, Open Dialogue provides the basis from which to challenge many of the perverse incentives and restrictive practices that have grown up in mental health care out of fear of incident, media criticism or what a regulator might say. Such as staff spending more time documenting care than in giving care. The absolute adherence to risk assessment even though successive independent investigations show it to have limited predictive value. And risk management, which taken to extremes means that those who might possibly pose a risk to themselves or others, are cared for in inhumane conditions with no privacy or dignity, no sheets, cutlery, shoelaces, phone chargers or indeed any other item that someone somewhere has said might pose a risk. And yet we know that ligatures and weapons can be fashioned from almost anything. And that people who are ill, frightened and alone can be driven to do increasingly desperate things. The greatest risk management tool available is compassionate, skilled attention. Open Dialogue offers high quantities of that.

Open Dialogue is being used in a growing number of services in the UK. A research bid has been submitted and passed the first round of scrutiny. If successful, it will explore human, clinical and cost effectiveness, as well as developing a model that is scalable and sensitive to local circumstances.

And to Corrine Hendy, who I first met at an NHS England event about putting patients first last year: Your journey from being locked in a mental hospital to becoming a skilled mental health professional, public speaker and highly effective advocate for Open Dialogue, is more inspirational than any you will hear on X-Factor. I want to repay the inspiration you have selflessly given.